EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/407647
EW CATARACT 28 November 2014 The art of advanced technology IOLs by Richard Tipperman, MD those services. At the conclusion of the discussion, our technician will say to the patient, "Dr. Tipperman will review all of your data and make a personal recommendation for you." What this means Going back to the education and car analogy, now when I see pa- tients they have already seen all the different "model car," options, and they understand the prices. Most importantly, they received this information before they saw me so it is presented in a non-threatening manner where they do not have to make a decision and instead can ask questions to be better educated (almost a virtual test drive). Now when I see patients, I can review all the clinical data and test- ing and perform a comprehensive clinical exam. Once this is complet- ed, I can discuss with patients the different options that they would have for IOL technology at the time of cataract surgery. The tremen- dous benefit of the "cart before the horse" approach is that the patient is already educated about these choices, has had a chance to have any specific questions answered, and already knows the financial costs associated with different technology choices. So my interaction with the patient becomes an educational one rather than a "selling" or "closing" interaction. This ultimately leads to a happi- er patient who is more comfortable and confident in his or her choice of IOL technology. This is one of the factors that helps produce quality outcomes because the patient knows the IOL choice is the best solution for his or her individual needs. One of the keys to the success of this approach is that it is a conversa- tion, not a script, and the discussion is different for each patient. EW Editors' note: Dr. Tipperman has no financial interests related to this article. Contact information Tipperman: rtipperman@mindspring.com physician has seen the patient and made a recommendation about IOL technology options, the patient will then see the "counselor" who may provide other clinical information on the suggested IOL technology and discusses the financial consid- eration. Although this model can work well for many offices, it closely mirrors the car dealership approach, and as such I would ask the reader to consider that there may be a better way to handle the entire process of educating patients, both about clinical advantages and financial implications of advanced technology IOLs. What we do We have developed an approach to patient education in our office that I would describe as "putting the cart before the horse." In our office, when patients come in for a cataract evaluation, their initial workup and diagnostic testing is performed by a highly trained and personable tech- nician whose skill set includes not only knowledge of biometry, IOL calculations, and diagnostic testing but also general ophthalmic techni- cal work. She has worked closely in the examining lane with both my partner and me and understands the criteria we use when we make a recommendation to a patient for an advanced technology IOL. For example, she understands that we might see a patient who is highly motivated for a presbyopic IOL solution but has a significant amount of astigmatism. In this instance we might recommend a toric IOL with monovision instead of a multifocal IOL. As the patient undergoes the initial diagnostic workup, our technician has a natural and relaxed conversation with the patient about his or her visual symptoms, day-to- day tasks, and lifestyle. As she has this discussion with the patient, she is able to review the diagnostic test- ing. Based on her knowledge of our past recommendations to patients, she begins to discuss what potential options the patient would have if he or she were to proceed with cataract surgery. During this discussion, she also explains why there are certain services that are not covered by insurance and what the patient's out-of-pocket expenses would be for or ill will perceived by some stems from how pricing is presented and how the sale is "closed." In most car dealerships, the discussion of price is a situation where the consumer has a complete lack of control, and it is this loss of control that causes a sense of discomfort and unease with the process. Clearly if we want our patients to make an educated, informed, and rational choice about their advanced technology IOL, we do not want to emulate the automotive sales model. Nonetheless, in breaking out the educational portion that occurs in an automotive dealership before the financial negotiations, it is clear that this is a very helpful and beneficial approach. Many offices offering advanced technology IOLs to their patients have some type of staff member who functions as an IOL counselor or coordinator. Typically, after the I n part one of this series, "An apology to used car salespeople," I reviewed the difference between educating and selling. Using car salespeo- ple as an example, we explored the notion that the initial interaction with a car salesperson is quite valuable and helpful. This is where he or she explains the different model cars and options that are available and allows the customer to take a test drive, so the customer can make an informed choice. None of these activities would cause the general public to think poorly of those in automotive sales. Instead the sentiment of mistrust Why you should put the cart before the horse: Educating vs. selling, part two Read the first part, "An apology to used car salespeople: Educating vs. selling, part one," in the July 2014 issue of EyeWorld, pages 39–40. Richard Tipperman, MD